New guidelines on obesity herald changes in coverage

July 11, 2012

Eat less, exercise more. Simple? Yes. Easy? No. If weight loss were easy, obesity rates among adults in the United States probably wouldn't have reached the current 36 percent.

Recently revised guidelines from the U.S. Preventive Services Task Force acknowledge that fact. They recommend that clinicians screen patients for obesity, which is defined as having a body mass index of 30 or higher. Further, they say patients who meet or exceed that level should be offered or referred to "intensive, multicomponent behavioral interventions" to help them lose weight.

The revised guidelines strengthen the previous recommendations, says David Grossman, a senior investigator at Group Health Research Institute in Seattle and a member of the task force.

For the millions of people who struggle to lose weight, the new guidelines offer much-needed support. It's unclear whether employers and insurers will welcome the change, though.

Under the 2010 health-care law, new health plans and those whose benefits change enough to lose their grandfathered status must provide services recommended by the Preventive Services Task Force at no cost to members. For the 70 percent of employers that already offer weight management programs, that may mean just supplementing what they already offer, says Russell Robbins, a senior clinical consultant at Mercer, a human resources consulting firm.

But some employers are concerned they may be on the hook for ongoing treatment as employees make repeated attempts to lose weight.

"From a financial standpoint, the guidelines are pretty broad and pretty extensive," says Helen Darling, president of the National Business Group on Health, which represents the interests of large firms. "Does this mean that employers and the government will be paying for up to 26 intense visits every year for every obese person for the rest of their lives?"

An HHS official said the department is evaluating whether to issue additional guidance on the new rules.

Insurers will be working to determine how best to satisfy the recommendations, says Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group.

"I think the real question is making sure there are programs that fulfill these requirements," she says.

According to the task force, effective weight-loss programs involve 12 to 26 group or individual sessions over the course of a year that cover multiple behavioral management techniques. These may include setting weight-loss goals and strategizing about how to maintain lifestyle changes, incorporating exercise and eating a more healthful diet, and learning to address the psychological and other barriers that create roadblocks to weight loss. The task force found that people in these programs generally lost nine to 15 pounds in the first year.

The task force said there wasn't enough evidence to determine whether such interventions worked for people who were overweight but not obese.

A number of existing programs provide the kind of care that the guidelines recommend, say experts.

Weight Watchers, for example, runs 20,000 meetings a week around the country where people discuss their weight-loss challenges and successes and get pointers on losing weight and keeping it off.

At $42.95 a month for access to group meetings and online food tracking and other tools, however, it's not an option for many people with limited incomes, who make up a disproportionate share of the obese. Some employers subsidize their employees' membership in the program. Under the new guidelines, insurers and employers could be responsible for paying 100 percent of the cost.

Other programs have also been successful. Two years ago, the Centers for Disease Control and Prevention, in partnership with UnitedHealth Group and the YMCA, launched the National Diabetes Prevention Program for people at high risk for developing Type 2 diabetes.

The program is based on a study in which participants who learned to eat more healthfully and exercised at least 150 minutes a week lost 5 to 7 percent of their weight and reduced their risk of developing diabetes by 58 percent.

The program is offered by many YMCAs and other groups. It offers each participant 16 weekly group weight-loss sessions followed by six monthly sessions. It's a covered benefit for many people with UnitedHealthcare or Medica insurance; others pay based on a sliding scale, says Ann Albright, director of CDC's Division of Diabetes Translation. CDC is working with Medicaid and Medicare to try to get it covered by those programs, says Albright.

John Joseph IV tipped the scales at 203 and had a BMI of 28.3 when he paid $150 to join the program at the YMCA near his Birmingham, Ala., home. In the four months since then, the 34-year-old, who runs a job-coaching business for college grads, has dropped 17 pounds.

At the weekly group meetings, he learned to count the fat grams in food and to make smarter food choices. Now he eats fewer cookies and more flounder. He started an exercise program and runs or lifts weights for 30 minutes three times a week.

"I thought, if I can do this, it will give me the infrastructure and habits so I can get to the mid-170s, which is where I want to be," he says.

Losing weight is hard, but keeping it off may be harder.

In 2009, Gayenell Magwood lost 100 pounds with the help of the weight management center at the Medical University of South Carolina in Charleston.

But after health problems curtailed her exercise routine for a few months, her weight crept up to 170, a gain of nearly 20 pounds. Magwood, 49, who lives in North Charleston and is a researcher in the College of Nursing at MUSC, went through the 15-week program all over again, at a cost of about $600. She lost the weight she had regained.

Before enrolling in the MUSC program, "I'd never once been successful with significant weight loss," she says.

- Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.